Journal of the Dow University of Health Sciences (JDUHS)

Systematic Review and Meta-Analysis for Evidence-Based Decision-Making in Public Health

Shahjahan Khan — 2025-06-10

Increasingly decisionmakers are using evidence-based approach in almost all leading areas of clinical practice, public health, education, business, public policy, climate science, and technology. The key ingredients of evidence-based decision-making are systematic review and meta-analysis.1 Systematic reviews are detailed, exhaustive and comprehensive literature review on a specific research topic with a view to identifying, appraising and synthesising the research findings from various relevant primary studies. A systematic review therefore extracts the relevant summary information or statistics from the selected studies without bias by strictly adhering to the review procedures and protocols.

Outcome of Laparoscopic versus Open Pyloromyotomy in Treatment of Infantile Hypertrophic Pyloric Stenosis

Mushkbar Naeem — 2025-06-10

Objective: To compare intraoperative and postoperative outcomes between laparoscopic and open pyloromyotomy in the treatment of infantile hypertrophic pyloric stenosis (IHPS).
Methods: This retrospective comparative study was conducted at the Department of Pediatric Surgery, Leeds General Infirmary, United Kingdom from May 2023 to April 2025. Infants aged from birth to 3 months with a confirmed diagnosis of infantile hypertrophic pyloric stenosis were included and grouped based on the surgical approach: laparoscopic or open pyloromyotomy. Primary outcomes included operative time, postoperative pain (assessed using the visual analogue scale), time to full feeding, complications and re-do surgery.
Results: A total of 61 infants with infantile hypertrophic pyloric stenosis, with 30 undergoing laparoscopic and 31 undergoing open pyloromyotomy. The median age at surgery and weight were 38.0 days (31.0–49.0) and 3.8 kg (3.3–4.1). The median operative time was insignificantly longer in the laparoscopic group 70.0 minutes (51.2-86.2) compared to the open group 64.0 minutes (49.0-70.0) (p-value = 0.225). However, the median postoperative pain score was significantly lower in the laparoscopic group compared to the open group i.e., 3.0 (3.0-4.0) vs. 5.0 (5.0-6.0) (p-value < 0.001). Time to full feeding was 24.0 hours in both groups, and the median length of hospital stay was 3.0 days. Re-do pyloromyotomy was required in 2 patients (6.7%) in the laparoscopic, while no re-do operations were needed in the open group.
Conclusion: Laparoscopic pyloromyotomy is associated with lower postoperative pain compared to open pyloromyotomy, with slightly longer operative time but similar time to full feeding and hospital stay.

Frequency and Risk Factors of Tuberculosis in End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis

Murik Rani Tanwani — 2025-06-10

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Comparison of Outcomes of Classical Lichtenstein and Modified Lichtenstein in Patients with Indirect Inguinal Hernia

Ghulam Fatima Komal Memon — 2025-06-10

Objective: This study aimed to compare the outcomes of classical Lichtenstein and modified Lichtenstein techniques in patients with indirect inguinal hernia.
Methods: This prospective cross-sectional study was conducted at the Department of Surgery, Ghulam Muhammad Mahar Medical College, from September 2024 to February 2025. Patients aged 18–70 years (American Society of Anesthesiologists class I–III) undergoing surgery for indirect inguinal hernia were included and equally divided into classical and modified Lichtenstein repair groups. Baseline characteristics including age, gender, residence, body mass index, diabetes, hypertension, and smoking status were recorded. Primary outcomes included operative time (minutes), postoperative pain score, surgical site infection, and hospital stay duration (days).
Results: Of the total 68 patients included, the median age was 47.0 years (40.2–54.0). There were 26 (38.2%) males and 42 (61.8%) females. The median duration of the surgical procedure was significantly shorter in the classical group at 38.5 minutes (35.0–41.2) compared to 50.5 minutes (40.7–54.0) in the modified group (p-value <0.001). Postoperative pain scores, assessed using the visual analogue scale, were consistently significantly lower in the modified group across all time points (p-value <0.001). The length of hospital stay was also significantly shorter in the modified group, with a median of 2.0 days (2.0–3.0) compared to 3.0 days (3.0–4.0) in the classical group (p-value =0.016).
Conclusion: Although the classical Lichtenstein technique resulted in a shorter operative duration, the modified technique was associated with significantly lower postoperative pain and a shorter hospital stay, indicating improved recovery outcomes.

Association between Clinical Presentations and Magnetic Resonance Imaging Findings in Single Level Lumbar Disc Prolapse in a Tertiary Care Hospital

Muneeza Adam Khatri — 2025-06-10

Objective: To determine the frequency of clinical presentations (neurological signs and symptoms) and assess their association with magnetic resonance imaging (MRI) findings in patients with single-level lumbar disc prolapse.
Methods: This cross-sectional study was conducted at the Department of Neurosurgery, Shifa International Hospital, Islamabad, from August 2024 to December 2024. The study included adults over 18 years, with or without lower back or leg pain, who consented to MRI of the lumbosacral spine. Neurological signs and symptoms, including numbness, paresthesia, neurogenic claudication, motor weakness, and diminished reflexes, were assessed. Neurological deficit was defined as the presence of one or more symptoms. MRI findings were categorized by disc level, type of disc prolapse, and nerve root compression.
Results: Out of 85 patients with single-level disc prolapse, numbness was the most common clinical symptom reported in 44 (51.8%) patients. MRI most commonly revealed involvement at L5/S1 and L4/L5 i.e., 43 (50.6%) and 34 (40.0%). Neurological deficit was observed in 66 (77.6%) patients. There was no significant association between neurological deficit and disc level (p-value =0.913), character of disc bulge (p-value =0.460), and nerve root compression (p-value =0.348). However, patients clinically diagnosed with lumbar disc prolapse had a significantly higher prevalence of neurological deficit (p-value < 0.001).
Conclusion: Over three-fourths of patients with single-level lumbar disc prolapse had neurological deficits, with numbness being the most common symptom. No significant link was found between MRI findings and neurological deficits, but clinical diagnosis was strongly associated with them.